Provider Demographics
NPI:1407960768
Name:JOSHI, DIMPLE AJAY (PA-C)
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:AJAY
Last Name:JOSHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602478
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2478
Mailing Address - Country:US
Mailing Address - Phone:704-403-6100
Mailing Address - Fax:704-403-6131
Practice Address - Street 1:100 MEDICAL PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2948
Practice Address - Country:US
Practice Address - Phone:704-403-6100
Practice Address - Fax:704-403-6131
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104215363AM0700X
SC911363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407960768Medicaid
SC0306PAMedicaid
P00307924OtherRAILROAD MEDICARE
NCNCG163FMedicare PIN
NCNCG163BMedicare PIN
NC1407960768Medicaid
NCNCG163EMedicare PIN
NCNCG163DMedicare PIN
SC0306PAMedicaid
NCNCG163GMedicare PIN
NCNCG163AMedicare PIN
NCNCG163CMedicare PIN